Risk för fotsår vid diabetes : Är objektiva riskfaktorer associerade med upplevd risk?

Sammanfattning: Foot ulcers are a common and difficult complication of diabetes, and can end with amputation of the foot. Although some patients fear amputation more than death, adherence to self-care to prevent ulceration is generally low. This raises the question about how people at risk of foot ulcerations perceive risks. The aim the thesis is to explore whether people with and without known risk factors for foot ulcerations (male gender, previous foot ulcer, and previous amputation) experience different levels of probability of developing foot ulcers the coming 12 months. A questionnaire was sent to 1230 patients at two prosthetics and orthotics clinics in Örebro and Gothenburg. 443 responses were included in the analysis. The association between each risk factor and perceived risk of foot ulcer was investigated with a Mann-Whitney test and Chi-square test. Subsequently, all risk factors were included in a multiple logistic regression analysis with perceived foot ulcer risk as the dependent variable. The Mann-Whitney test and Chi-square test showed that people with previous foot ulcers experienced significantly higher risk (p<0.05) than people without previous foot ulcers and people with amputation experienced higher risk than people without amputation. Gender was not significantly associated with perceived foot ulcer risk. In the logistic regression analysis, previous foot ulcer was significantly associated with higher perceived risk of future foot ulcers, while sex and amputation were not significant. Presumably, amputation was not significant in the logistic regression analysis because there was a strong association between previous foot ulcer and amputation. The model explained only 8,3 % of the variance in perceived foot ulcer risk, which indicates that there may be several other factors affecting perceived risk of foot ulcers. The lack of significant association between sex and perceived risk can be interpreted as an optimism bias among men and/or a pessimism bias among women, which would be interesting to investigate further in future research. Future studies should use more precise methods to measure subjective risk, measure the negative value of foot ulcers and investigate interventions to promote a more realistic perception of risk to promote self-care and reduce risk of foot ulcer.